If the two companies cannot reach an agreement on reimbursement rates by Jan. 15, Oregonians with Regence insurance will not be covered at Providence facilities.
Portland, Oregon. Time is running out for contract renewal negotiations between a major Portland hospital group and a major Oregon insurance company, leaving the fate of health care for more than 260,000 Oregonians hanging in the balance.
Providence Health & Services is seeking increased reimbursement rates from insurer Regence Blue Cross Blue Shield in response to rising health care costs and employee wages. Providence said drug and supply prices increased 19% from 2020 to 2022 and are still rising, and the company also pointed to “large monetary losses since the COVID-19 pandemic began.”
In a news release two weeks earlier, Regence said Providence had sought a “huge double-digit price increase” that would cost more than $144 million in just one year, and claimed the result would be higher premiums and out-of-pocket expenses. There will be an out-of-pocket fee. , For example, the cost of having a baby by C-section increases to about $5,500.
If the two companies do not reach an agreement by the current contract’s Jan. 15 expiration date, Providence will leave the Regence network, meaning patients with Regence insurance will have to begin paying out-of-network rates at Providence hospitals. Unless an agreement is reached, Providence will also leave the Regence Medicare Advantage Network on Feb. 15.
“I’m concerned about all the people in this area, there are so many people who depend on Providence for their health care,” said Kendall Stowell, who works near Providence Portland Medical Center.
Those people include Mary Grabies and her children, who rely on the Providence system for specialized care. Grabis said her children have emotional and intellectual disabilities, but Providence offers a program that has been a “saving grace” for the family. He said that if the companies did not reach an agreement, his family would be seriously affected.
He said, “It would probably mean that we would have to travel out of town to get such programs, or it might even mean that we would have to pay more out of pocket than we do right now.” “
Providence said in a statement that it hoped an agreement could be reached within the next four weeks without disrupting patient care. Providence urged patients covered by Regence to contact their insurance provider if they have questions.
Providence said, “We are working tirelessly to combat rising costs, yet we cannot do it all because failing to account for these costs will jeopardize our ability to adequately pay the dedicated individuals who work in our clinics and hospitals. Capacity is affected.”
Last summer, Providence nurses went on strike and ultimately won historic pay increases, which the hospital said also increased financial pressures on it.
Regence said in a statement that it is “fully committed to continuing negotiations and reaching an agreement that preserves our long-term affiliation with Providence Health.”
“Regence regularly works with providers across our state on network contracts that help control care costs for our members,” the company said. “Our premiums are based on what we expect the cost of care to be. If providers demand more money, our members and customers will pay more. These negotiations are not about Regence; they are about our customers. We are in. We act as their advocates during these discussions.”
“The way health care is set up these days and the way it has been over the last few years, it doesn’t surprise me at all when it comes to medicine and health care,” Grabies said.
Their goal should be to serve more people, to serve as many people as possible,” Stowell said.
BlueCross BlueShield is a brand name shared by a consortium of individual health insurance companies across the country; The dispute with Providence is specific to Regence BlueCross BlueShield of Oregon.
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